Health

This summary is part of a research project carried out between March and October 2006 in support of the International Institute for Communication and Development (IICD), one of The Communication Initiative (The CI)'s partners.

As noted within this case study, due to socio-economic and climatic factors, Cape Town has one of the highest tuberculosis (TB) infection rates in the world. The drug treatment regime for TB is difficult, but must be strictly followed in order to effectively treat the virus. Non-compliance with the drug treatment has further complicated the problem of high TB infection rates and has imposed a large burden on the already overstretched public healthcare system in Cape Town. Moreover, non-compliance wastes precious medicines and causes the TB virus to become increasingly resistant to the treatment. Evidence suggests that in most cases TB patients fail to take their medication because they simply forget. Over 50 percent of people in the Cape Peninsula have access to cell phones.

A health consultant in Cape Town, South Africa, Dr. David Green was well aware of the high rates of TB infection. Owing to his PhD research in pharmacology, a chronically forgetful mother, and a little common sense it was not long before Dr. Green was making the connection between TB treatment compliance and Short Message Service (SMS) messaging. So, in 2002 he convinced the City of Cape Town's health directory to run a pilot project testing the use of cell phone technology to remind patients to take their medicine at one of the city's clinics. At the clinic where the pilot study was conducted, 71 percent of TB patients had access to a cell phone. The pilot was very successful, resulting in only one treatment failure of the 138 patients involved.

The primary objective of the project is to alert TB patients to take their medication through the use of SMS, therefore increasing recovery rates of patients and lessening the financial and physical burden on the public healthcare system.

According to this study, Dr. Green uses low-cost and robust technology, such as an open source software operating system, web server, mail transport agent, applications, and a database to send personalised messages every half an hour to TB patients, who have been inputted into a central database, to remind them to take their medication. He charges the local health authority R11.80 per patient per month to run the SMS reminder service.

The following outcomes have been observed:

• The success rate of the pilot project was nearly 100 percent;
• The World Health Organization (WHO) has cited the project as an example of "international best practice"; and
• A randomised control trial has been launched, involving South Africa's Medical Research Council (MRC), the University of Cape Town (UCT) and Dr. Green, to compare the cost-effectiveness of the SMS-reminder service against the cost of non-compliance to TB treatment.

The following challenge was noted:

• Local healthcare professionals were skeptical about the number of patients who would have access to cell phones and thus initially resisted Dr. Green’s efforts to conduct a pilot.

Key factors leading to the success of the project:

• Locating his information technololgy (IT) business at UUNET Bandwidth Barn has provided The Compliance Service (now known as SIMpill) with affordable office rentals, shared office facilities, and reduced internet connectivity costs. In addition, SIMpill uses freely available open source software to deliver its services. These factors combined have enabled SIMpill to provide its service at a very affordable price so that more people can use and benefit from the technology;
• Convincing the City of Cape Town's health directory to run a pilot at one of the city's clinics has encouraged the use of this technology for the public healthcare system as opposed to the private; and
• Dr. Green ensured patient buy-in for the technology by responding to their feedback.

An extension of the pilot project to other city clinics, where cell phone ownership of patients is high, has been initiated by the City Council of Cape Town. MRC and UCT are conducting a critical, independent review of the pilot project. The outcome of the trial will be published in four research papers that will be subjected to peer review. The South African Government is considering the technology for nationwide use and the system is also being investigated for use with HIV treatment.